Micronized wharton&#39;s jelly

ABSTRACT

The present invention provides compositions and formulations of micronized Wharton&#39;s jelly having a controlled viscosity such that when delivered to the injured region of a subject, it remains substantially localized with little or no migration out of the injured region for the repair and/or regeneration thereof. Micronized Wharton&#39;s Jelly can be suspended in a pharmaceutically acceptable aqueous carrier, such as saline, sterile water, or any suitable buffer, to form a suspension or a gelatinous gel composition, or it can be in the form of a paste, suitable for delivery into the space adjacent the articular surface cartilage injured region of a subject. The micronized Wharton&#39;s jelly when employed at sufficient concentrations can be hydrated into a gel or paste and administered topically, or it can be injected into the body through the use of a needle and syringe. Accordingly, micronized Wharton&#39;s Jelly, compositions, or formulations thereof, can be delivered in a manner that is more convenient than Wharton&#39;s jelly that has not been micronized in accordance with the present invention.

CROSS REFERENCE TO RELATED APPLICATIONS

This application is a Continuation Application of U.S. patentapplication Ser. No. 15/166,016, filed May 26, 2016, which claims thebenefit of U.S. patent application Ser. No. 14/793,673, filed Jul. 7,2015, which claims the benefit of U.S. Provisional Application Ser. No.62/022,084, filed Jul. 8, 2014, the entirety of each of which areincorporated herein by reference.

FIELD OF THE INVENTION

The present invention is directed to micronized Wharton's jelly,compositions and formulations comprising the micronized Wharton's jelly,and methods of using micronized Wharton's jelly and compositions andformulations thereof.

BACKGROUND OF THE INVENTION

Articular surface defects include injuries as a result of sport relatedtrauma, impact injury or a past injury persisting for prolonged timeperiods. The acute and repetitive impact and torsional joint loadingthat occurs, for example, during participation in sports can damagearticular surfaces causing pain, joint dysfunction, and effusions. Insome instances, this particular surface damage leads to progressivejoint degeneration and osteoarthritis of the joint. In most instances,joints can repair damage that does not disrupt the articular surface ifthey are protected from additional injury. Mechanical disruption ofarticular cartilage stimulates chondrocyte synthetic activity, but itrarely results in repair of the injury. Disruption of subchondral bonestimulates chondral and bony repair, but it rarely restores an articularsurface that duplicates the biologic and mechanical properties of normalarticular cartilage. Articular surface defects are difficult to heal orregenerate spontaneously.

Wharton's jelly is a viscous gelatinous substance found in the umbilicalcord of mammals (hereinafter referred to as ‘Native Wharton's Jelly’).Native Wharton's Jelly contains high amounts of host extracellularmatrix (ECM) components (including chondroitin sulfate, collagen,hyaluronic acid (HA), proteoglycans, and stem cells. Native Wharton'sJelly may also include growth factors such as, for example, fibroblastgrowth factor (FGF), insulin-like growth factor I (IGF-I), transforminggrowth factor beta (TGF-beta), platelet-derived growth factor (PDGF) andepidermal growth factor (EGF). Native Wharton's Jelly also has asignificant elasticity characteristic as well as binding of watermolecules.

In particular surface defects, the approach in addressing this conditionis one of “repair or regeneration”. “Repair” refers to healing of theinjured tissue or replacement by cell proliferation and new ECM.“Regeneration” refers to formation of entirely new articular surfacewhich is identical to the original tissue. Key growth factors which canchemotactically cause cell proliferation, deliver ECM and cellulardifferentiation to hyaline cartilage are introduced to aid repair orregeneration.

While Native Wharton's Jelly is contemplated to provide essentialelements for both the repair and regeneration of articular surfacecartilage, it is a viscous gelatin that is difficult to deliver into thebody for repair and/or regeneration. Accordingly, there is a need toprovide Native Wharton's Jelly that can be readily and reliablydelivered to the injured region of a subject for repair and/orregeneration of the articular surface cartilage thereof.

SUMMARY OF THE INVENTION

In one aspect, the present invention provides compositions andformulations of micronized Native Wharton's Jelly having a controlledviscosity such that when delivered to the injured region of a subject,it remains substantially localized with little or no migration out ofthe injured region for the repair and/or regeneration thereof. In someembodiments, micronized Native Wharton's Jelly according to the presentinvention can be suspended in a pharmaceutically acceptable aqueouscarrier, such as saline, sterile water, or any suitable buffer known inthe art, to form a suspension or a gelatinous gel composition, or it canbe in the form of a paste, suitable for delivery into the space adjacentthe articular surface cartilage injured region of a subject as describedherein. As such, the micronized Native Wharton's Jelly in accordancewith the present invention is versatile because when employed atsufficient concentrations, it can be hydrated into a gel or paste andadministered topically, or it can be injected into the body through theuse of a needle and syringe. In at least these respects, micronizedNative Wharton's Jelly, compositions, or formulations thereof, can bedelivered in a manner that is more convenient than Native Wharton'sjelly that has not been micronized in accordance with the presentinvention.

DETAILED DESCRIPTION OF THE INVENTION

It is to be understood that the aspects of the present invention asdescribed below are not limited to specific compositions, methods orpreparing such compositions, or uses thereof, as such may, of course,vary. It is also to be understood that the terminology used herein isfor the purpose of describing particular aspects only and is notintended to be limiting.

As set forth in the specification and in the appended claims thatfollow, reference will be made to a number of terms that shall bedefined to have the following meanings:

As used in the specification and the appended claims, the singular forms“a”, “an” and “the” include plural referents unless the context clearlydictates otherwise. Thus, for example, reference to “a bioactive agent”includes a single bioactive agent and mixtures of two or more bioactiveagents, and the like.

The term “Optional” or “optionally” means that the subsequentlydescribed event or circumstance can or may occur, or cannot or may notoccur, and that the description includes instances where the event orcircumstance occurs and instances where it does not. For example, thephrase “optionally cleaning step” means that the cleaning step may ormay not be performed.

The term “comprising” is intended to mean that the compositions andmethods include the recited elements, but not excluding others.“Consisting essentially of” when used to define compositions andmethods, shall mean excluding other elements of any essentialsignificance to the combination. For example, a composition consistingessentially of the elements as defined herein would not exclude otherelements that do not materially affect the basic and novelcharacteristic(s) of the claimed invention. “Consisting of” shall meanexcluding more than trace amount of other ingredients and substantialmethod steps recited. Embodiments defined by each of these transitionterms are within the scope of the present invention.

The term “subject” or “patient” as used herein means any vertebrateorganism including but not limited to mammalian subjects such as humans,domestic animals such as cows, pigs, horses, dogs, cats, rabbits, ratsand mice, and non-domesticated animals.

The term “placental tissue” means any and all of the well-knowncomponents of the placenta including but not limited to amnion, chorion,and the like, and including processed tissue, such as dehydratedplacental tissue and micronized placental tissue. The term “placentaltissue” as used herein does not include any of the components found inan umbilical cord, (e.g., Native Wharton's Jelly, umbilical cord veinand artery, and surrounding amniotic membrane.

The term “about” when used before a numerical value is inclusive of thestated value and has the meaning dictated by the context (e.g., includesthe degree of error associated with measurement of the particularquantity, such as ±5%, ±1%, and ±0.2%).

The term “dehydrated” when defining a substance, such as micronizedNative Wharton's Jelly, amnion, chorion, and the like, means that thesubstance has a water content of no more than about 10%, no more thanabout 5%, no more than about 1%, no more than about 0.5%, no more thanabout 0.2%, no more than about 0.1%, or no more than about 0.01%, or isfree of any water. The term “dehydrate” or “dry”, “dried” or anygrammatical equivalent means to substantially remove water (e.g., toremove at least about 85%, about 90%, about 95%, about 99%, about 99.5%,about 99.8%, about 99.9% or about 99.99% of the water content in thesubstance) or to completely remove water from a substance to produce adehydrated substance free of any water content.

The term “treatment” or “treating”, to the extent it relates to adisease or condition, includes preventing the disease or condition fromoccurring, inhibiting the disease or condition, eliminating the diseaseor condition, and/or relieving one or more symptoms of the disease orcondition.

Abbreviations

The following abbreviations when used throughout the specification andthe appended claims, have the following meanings:

-   -   ° C.=degrees Celsius    -   cc=cubic centimeter    -   cm=centimeter    -   Da=Dalton    -   DI=de-ionized    -   DMSO=dimethyl sulfoxide    -   EDTA=ethylenediaminetetraacetic acid    -   M=molar concentration (mol/L)    -   mg=milligram    -   mL=milliliter    -   mm=millimeter    -   PBS=phosphate buffered saline    -   rpm=rounds per minute    -   μm=micrometer

Titles or subtitles may be used in the specification for the convenienceof a reader, which are not intended to influence the scope of thepresent invention. Additionally, some terms used in this specificationare more specifically defined below.

I. Native Wharton's Jelly

The umbilical cord (also called the navel string, birth cord orfuniculus umbilicalis) is a conduit between the developing embryo orfetus and the placenta. During prenatal development, the umbilical cordis physiologically and genetically part of the fetus and, in humans,normally contains two arteries (the umbilical arteries) and one vein(the umbilical vein), surrounded by Native Wharton's Jelly. The outerlayer of the umbilical cord is sheathed in amniotic membrane.

According to the present invention, Native Wharton's Jelly can beobtained from the umbilical cord of mammals such as humans, domesticanimals such as cows, pigs, horses, dogs, cats, rabbits, rats and mice,and non-domesticated animals. Native Wharton's Jelly contains highamounts of host extracellular matrix (ECM) components (includingchondroitin sulfate, collagen, hyaluronic acid (HA), proteoglycans, andstem cells. Native Wharton's Jelly may also include growth factors suchas, for example, fibroblast growth factor (FGF), insulin-like growthfactor I (IGF-I), transforming growth factor beta (TGF-beta),platelet-derived growth factor (PDGF) and epidermal growth factor (EGF).Native Wharton's Jelly also has a significant elasticity characteristicas well as binding of water molecules.

According to the present invention, Native Wharton's Jelly is collectedthrough the gross processing of umbilical cord as described in greaterdetail below. The collected Native Wharton's Jelly is then dehydrated,followed by micronization, as described in greater detail below.

Umbilical Cord Tissue Collection

In the case of humans, the recovery or collection of umbilical cordtissue can be achieved, for example, in a hospital, where it ispreferably collected during a Cesarean section birth. The donor,referring to the mother who is about to give birth, voluntarily submitsto a comprehensive screening process designed to provide safe tissue formedical use. The screening process preferably tests for antibodies tothe human immunodeficiency virus type 1 and type 2 (anti-HIV-1 andanti-HIV-2), antibodies to the hepatitis B virus (anti-HBV) hepatitis Bsurface antigens (HBsAg), antibodies to the hepatitis C virus(anti-HCV), antibodies to the human T-lymphotropic virus type I and typeII (anti-HTLV-I, anti-HTLV-II), cytomegalovirus (CMV), and syphilis, andnucleic acid testing for human immune-deficiency virus type 1 (HIV-1)and for the hepatitis C virus (HCV), using conventional serologicaltests. The above list of tests is exemplary only, as more, fewer, ordifferent tests may be desired or necessary over time or based upon theintended use of the tissue, as will be appreciated by those skilled inthe art.

Based upon a review of the donor's information and screening testresults, the donor will either be deemed acceptable or not. In addition,at the time of delivery, cultures are taken to determine the presence ofbacteria such as, for example, Clostridium or Streptococcus. If thedonor's information, screening tests, and the delivery cultures are allsatisfactory (i.e., do not indicate any risks or indicate acceptablelevel of risk), the donor is approved by a medical professional and thetissue specimen is designated as initially eligible for furtherprocessing and evaluation.

The umbilical cord tissue that is dissected off the placental discduring standard process and meets the above selection criteria can beprocessed immediately in accordance with the present invention, or itcan be stored in a reservoir such as in a sterile shipment bag orcontainer containing saline solution, which is then stored in a wet iceenvironment for shipment to a processing location or laboratory forprocessing in accordance with the present invention.

Gross Umbilical Cord Tissue Processing

An umbilical cord that is dissected from the placental disc as describedabove is first processed by making an incision along the umbilical cordat a depth of about 2 mm to about 3 mm, to thereby expose the arteries,veins and Native Wharton's Jelly. As would be understood by a person ofordinary skill in the art, the depth of the incision may of course varydepending upon the diameter or thickness of the dissected umbilicalcord. The umbilical cord arteries and veins are then removed byutilizing, for example, undermining dissection techniques known in theart, with care given to maintain as much of the Native Wharton's Jellyas possible, to thereby provide umbilical cord tissue comprising NativeWharton's Jelly and umbilical cord amniotic membrane (hereinafterreferred to as ‘Umbilical Cord Tissue’). To increase the dissection andrecovery of Native Wharton's Jelly from the Umbilical Cord Tissue, theumbilical cord may be cut into smaller sections, such as for exampleumbilical cord sections of about 4 cm to about 10 cm in length It is tobe understood that, according to the present invention, the UmbilicalCord Tissue may or may not include amniotic membrane. For example, incertain aspects of the present invention, the Native Wharton's Jelly canbe further isolated from the Umbilical Cord Tissue by dissecting theamniotic membrane from the Native Wharton's Jelly to thereby provideNative Wharton's Jelly free on any umbilical cord components(hereinafter referred to as “Isolated Wharton's Jelly”). The IsolatedWharton's Jelly can be, for example, further cut into strips of about 1cm to about 4 cm by about 10 cm to about 30 cm, with a thickness ofabout 1.25 cm, although, other thicknesses are possible depending on thedesired application.

According to the present invention, Umbilical Cord Tissue, or IsolatedWharton's Jelly, is rinsed and cleaned according to the standard Purion®process wash and rinse step as described in “PURION® ProcessedDehydrated Human Amnion/Chorion Membrane Allografts”, 2012, available athttp://www.iopinc.com/wp-content/uploads/2012/05/Ambio_AM_Process_Monograph-May-12.pdf. For example,

Dehydration

Unless otherwise indicated herein, the dehydration steps describedherein can be employed for dehydration of Umbilical Cord Tissue orIsolated Wharton's Jelly. Accordingly, reference to dehydration ofUmbilical Cord Tissue is intended to include, and may be referred tointerchangeably with, Isolated Wharton's Jelly, unless otherwiseindicated. After the washing and rinsing steps described above arecompleted, the Umbilical Cord Tissue can be dehydrated according totechniques described in greater detail below or as otherwise known inthe art. In one aspect, Umbilical Cord Tissue can be placed onto adrying board. Exemplary drying boards include those described in, forexample, U.S. Patent Application Publication No. US2014/0106447. In thecase of Umbilical Cord Tissue that includes an intact amniotic membrane,the Umbilical Cord Tissue is place on the drying board with the NativeWharton's Jelly side facing upwards. The Umbilical Cord Tissue is thendried according to dehydration specifications described herein or as maybe otherwise known in the art. For example, the Umbilical Cord Tissuecan be dehydrated to substantially remove water from the Umbilical CordTissue (i.e., greater than about 90%, greater than about 95%, or greaterthan about 99%, of water present in the tissue is removed), or can bedehydrated to completely remove all water present in the Umbilical CordTissue (i.e., 100% of the water present in the Umbilical Cord Tissue isremoved).

In one aspect, the Umbilical Cord Tissue is dehydrated by chemicaldehydration followed by freeze-drying. For example, the chemicaldehydration step is performed by contacting the Umbilical Cord Tissuewith a polar organic solvent for a sufficient time and amount. Thesolvent can be protic or aprotic. Examples of polar organic solventsuseful herein include, but are not limited to, alcohols, ketones,ethers, aldehydes, or any combination thereof. Specific, non-limitingexamples include DMSO, acetone, tetrahydrofuran, ethanol, isopropanol,or any combination thereof. In one aspect, the Umbilical Cord Tissue iscontacted with a polar organic solvent at room temperature. Noadditional steps are required, and the Umbilical Cord Tissue can befreeze-dried directly as described below.

After dehydration, the Umbilical Cord Tissue can be freeze-dried inorder to remove any residual water and polar organic solvent. In oneaspect, the Umbilical Cord Tissue can be laid on a suitable dryingfixture prior to freeze-drying. The drying fixture is preferably sizedto be large enough to fully receive the Umbilical Cord Tissue, in a laidout, flat fashion. In one aspect, the drying fixture is made of Teflon®or of Delrin®, which is the brand name for an acetal resin engineeringplastic sold by DuPont and which is also available commercially fromWerner Machine, Inc. Marietta, Ga. Any other suitable material that isheat and cut resistant, capable of being formed into an appropriateshape to receive wet Umbilical Cord Tissue, can also be used for thedrying fixture.

Once the Umbilical Cord Tissue is placed on the drying fixture, thedrying fixture is placed in a freeze-dryer. The use of a freeze-dryer todehydrate the Umbilical Cord Tissue can be more efficient and thoroughas compared to other techniques such as thermal dehydration. In someembodiments, it is desirable to avoid ice crystal formation in theUmbilical Cord Tissue as this may damage the extracellular matrix in theUmbilical Cord Tissue. By chemically dehydrating the Umbilical CordTissue prior to freeze-drying, the formation of ice crystals and damageto the extracellular matrix can be avoided.

In another aspect, the dehydration step involves applying heat to theUmbilical Cord Tissue. For example, the Umbilical Cord Tissue is laid ona suitable drying fixture or board as described above, and the dryingfixture is placed in a sterile Tyvex (or similar, breathable,heat-resistant, and sealable material) dehydration bag and sealed. Thebreathable dehydration bag prevents the Umbilical Cord Tissue fromdrying too quickly. If multiple drying fixtures are being processedsimultaneously, each drying fixture is either placed in its own Tyvexbag or, alternatively, placed into a suitable mounting frame that isdesigned to hold multiple drying frames thereon and the entire frame isthen placed into a larger, single sterile Tyvex dehydration bag andsealed.

The Tyvex dehydration bag containing the one or more drying fixtures isthen placed into a non-vacuum oven or incubator, that has been preheatedto about 35° C. to about 50° C., for between about 30 to about 120minutes. In one aspect, the heating step can be performed for about 45minutes at a temperature of about 45° C. to dry the Umbilical CordTissue sufficiently while at the same time without over-drying orburning the umbilical cord tissue. The specific temperature and time forany specific oven should be calibrated and adjusted based on otherfactors such as altitude, size of the oven, accuracy of the oventemperature, material used for the drying fixture, number of dryingfixtures being dried simultaneously, whether a single or multiple framesof drying fixtures are dried simultaneously, and the likeconsiderations.

While the dehydration of Umbilical Cord Tissue may be achieved by usingdehydration devices known in the art, an innovative dehydration devicewhich enhances the rate and uniformity of the dehydration process asdescribed in U.S. Patent Application Publication No. US2014/0051059,which is incorporated herein by reference in its entirety, may beutilized. For example, in one embodiment, the drying time can beaccelerated by up to about 40% in one configuration of such dehydrationdevice in comparison to conventional drying ovens. In certain aspects ofthis embodiment, the Umbilical Cord Tissue is placed onto a dryingfixture described herein and the drying fixture with the Umbilical CordTissue is inserted into the dehydration device for performing thedehydration process. In other aspects, multiple Umbilical Cord Tissuescan be placed onto the drying fixture to simultaneously dry more thanone Umbilical Cord Tissue in the dehydration device.

Preparation of Micronized Wharton's Jelly

After dehydrating the Native Wharton's Jelly or Umbilical Cord Tissue asdescribed in detail above or as may otherwise be known in the art(collectively or individually, “Dehydrated Tissue”), the DehydratedTissue is micronized in accordance with the present invention to form aparticle distribution comprising particles of one or more sizes(hereinafter referred to as “Micronized Wharton's Jelly”). For example,the Dehydrated Tissue can be cut into sections of about 2 cm by about 2cm and prepared for micronization. The micronization can be achievedusing instruments known in the art. For example, the Retsch OscillatingMill MM400 (manufactured by and available from Retsch GmbH, Retsch-Allee1-5, 42781 Haan, Germany) can be used to produce the MicronizedWharton's Jelly described herein.

In one aspect, the Micronized Wharton's Jelly is prepared by mechanicalgrinding or shredding of the Dehydrated Tissue.

In another aspect, Micronized Wharton's Jelly is prepared by cryogenicgrinding of the Dehydrated Tissue. In this aspect, a grinding jarcontaining the Dehydrated Tissue is continually cooled with liquidnitrogen from an integrated cooling system before and during thegrinding process. Thus, the sample is embrittled and volatile componentsare preserved. Moreover, the denaturing of proteins in the DehydratedTissue is minimized or prevented. For example, in one aspect, a CryoMillmanufactured by and available from Retsch GmbH can be used.

For example, Dehydrated Tissue described herein can be placed in vialsand the vials are subsequently sealed. The vials are placed in aCryo-block, and the Cryo-block is placed in a Cryo-rack, each of whichare manufactured by and available from Retsch GmbH. The Cryo-rack isplaced into a liquid nitrogen holding-Dewar flask. The Dehydrated Tissueis subjected to vapor phase cooling for no more than about 30 minutes toabout 60 minutes. The Cryo-rack is removed from the Dewar flask, and theCryo-block is removed from the Cryo-rack. The Cryo-block is placed intoa grinder (for example, SPEX Sample Prep GenoGrinder 2010, manufacturedand available from SPEX SamplePrep, 65 Liberty St., Metuchen, N.J.08840) and set at about 1,500 rpm for about 20 minutes. After about 20minutes has elapsed, the Micronized Wharton's Jelly is inspected toensure micronization in accordance with the particle size specificationsof the present invention as described in greater detail below. Ifnecessary, the Micronized Wharton's Jelly may be returned to the Dewarflask for an additional period of time, such as for example about 30minutes to about 60 minutes, and then placed in the grinder for anadditional period of time, such as for example about 20 minutes, toensure sufficient micronization and desired particle size distributionas described in greater detail below.

Separation of Micronized Wharton's Jelly particles by respective sizescan be achieved by fractionation of the Micronized Wharton's Jelly insterile water by forming a suspension of particles therein. According tosuch fractionation technique, the upper most portion of the suspensionwill contain predominantly the smallest particles and the lower mostportion of the suspension will contain predominantly the heaviestparticles. Fractionation leads to particle size separation and repeatedfractionation will lead to separation of the micronized particles intovarying sizes. The separated Micronized Wharton's Jelly particles canthen be recombined in the desired ratio of particle size as is mostappropriate for an intended use.

In another embodiment, separation is achieved utilizing one or moresieves having desired hole or pore sizes to achieve a desired particlesize distribution in accordance with the present invention. For example,once the Micronized Wharton's Jelly is prepared as described above, itcan be sorted by particle size using a series of sieves meeting thestandards and specifications of the American Society for Testing andMaterials (ASTM) s. For example, in some embodiments, sieves haverespective hole or pore sizes of 355 μm, 300 μm, 250 μm, 150 μm, and 125μm. The Micronized Wharton's Jelly is then sequentially transferred tothe 355 μm sieve, followed by the 300 μm sieve, followed by the 250 μmsieve, followed by the 150 μm sieve, and followed by the 125 μm sieve.Prior to transfer of the Micronized Wharton's Jelly to a subsequentsieve, the respective sieve is agitated individually in order tothoroughly separate by size the Micronized Wharton's Jelly particles. Inthis example, once the Micronized Wharton's Jelly particles areeffectively separated using the sieves, the Micronized Wharton's Jellyparticles having particle sizes of 355 μm, 300 μm, 250 μm, 150 μm, and125 μm are collected in separate labeled vials.

The particle size of the Micronized Wharton's Jelly can vary as welldepending upon the application. It is to be understood that the term“micronized” is meant to include micron and sub-micron sized particles.In one aspect, the Micronized Wharton's Jelly has particles that are ator less than about 500 μm, at or less than about 400 μm, at or less thanabout 300 μm, at or less than about 200 μm, at or less than about 100μm, at or less than about 75 μm, at or less than about 50 μm, at or lessthan about 25 μm, at or less than about 20 μm, at or less than about 15μm, at or less than about 10 μm, at or less than about 9 μm, at or lessthan about 8 μm, at or less than about 7 μm, at or less than about 6 μm,at or less than about 5 μm, at or less than about 4 μm, at or less thanabout 3 μm, at or less than about 2 μm, or from about 2 μm to about 400μm, from about 25 μm to about 300 μm, from about 25 μm to about 200 μm,or from about 25 μm to about 150 μm, or any range between any of the twonumbers. In one aspect, the Micronized Wharton's Jelly has particlesthat have a diameter of less than about 150 μm, less than about 100 μm,or less than about 50 μm. In other aspects, particles having a largerdiameter (e.g., about 150 μm to about 350 μm) are desirable. In otheraspects, the particles have a diameter of about 25 μm to about 75 μm. Inall cases, the diameter of the particle is measured along its longestaxis.

In some embodiments, the Micronized Wharton's Jelly has a desiredparticle size distribution such that, for example, smaller sizedparticles may provide an immediate or short-term effect and largerparticles may provide a prolonged or sustained long term effect. Forexample, in some embodiments, the Micronized Wharton's Jelly is acomposition comprising multiple particle sizes such that, for example,about 50% of the particles have a diameter of less than about 40 μM,about 25% of the particles have a diameter of from about 40 μM to lessthan about 60 μM, and about 25% of the particles have a diameter of morethan about 60 μM. In other embodiments, about 25% of the particles havea diameter of less than about 40 μM, about 25% of the MicronizedWharton's Jelly particles have a diameter of from about 40 μM to lessthan about 60 μM, and about 50% of the particles have a diameter of morethan about 60 μM.

In one embodiment, the surface area to volume ratio of the particles(based on a particle having a range of diameters as described above) isbetween the range of about 0.06 μm⁻¹ to about 6×10⁴ μm⁻¹, about 0.06μm⁻¹ to about 6×10³ μm⁻¹, about 0.06 μm⁻¹ to about 6×10² μm⁻¹, or about0.6 μm⁻¹ to about 6×10² μm⁻¹.

In one aspect, the Micronized Wharton's Jelly is substantially free ofany placental tissue or a component thereof. Substantially free as usedherein means that the Micronized Wharton's Jelly contains no more thanabout 10%, 5%, or 1% of placental tissue or a component thereof. In oneaspect, the Micronized Wharton's Jelly is free of any placental tissueor a component thereof.

As would be appreciated by one skilled in the art, the particle size ofthe Micronized Wharton's Jelly can be reduced to nano-range, therebysignificantly increasing the density of the Micronized Wharton's Jellyparticles and improving the release rate of the Micronized Wharton'sJelly particles upon application to a treatment site. For example, theMicronized Wharton's Jelly can be subjected to conventional methodsknown in the art, including differential centrifugation, therebyreducing the particle size to nano-range. Particle size reduction usinga suitable technology or device is within the purview of one skilled inthe art.

II. Micronized Wharton's Jelly Compositions

According to yet another aspect of the present invention, compositionsand formulations comprising Micronized Wharton's Jelly are provided.

As described above, Native Wharton's jelly is a viscous gelatinousmaterial that is difficult to deliver into the body for repair and/orregeneration. According to the present invention, the MicronizedWharton's Jelly, and compositions and formulations thereof, can bereadily and reliably delivered to the injured region of a subject forrepair and/or regeneration of the articular surface cartilage thereof.In one aspect, the present invention provides Micronized Wharton's Jellyand compositions thereof having a controlled viscosity such that whendelivered to the injured region of a subject, it remains substantiallylocalized for the repair and/or regeneration thereof. As described ingreater detail below, Micronized Wharton's Jelly according to thepresent invention can be suspended in a pharmaceutically acceptableaqueous carrier, such as saline, sterile water, or any suitable bufferknown in the art, to form a suspension or a gelatinous gel composition,that can be in the form of a liquid, gel, or paste suitable for deliveryinto the space adjacent the articular surface cartilage injured regionof a subject as described herein. As such, the Micronized Wharton'sJelly disclosed herein is versatile because when employed at sufficientconcentrations, it can be hydrated into a gel or paste and administeredtopically, or it can be injected into the body through the use of aneedle and syringe. In at least these respects, Micronized Wharton'sJelly according to the present invention, or compositions orformulations thereof, can be delivered in a manner that is moreconvenient than Native Wharton's jelly.

In one aspect, the Micronized Wharton's Jelly described herein can beformulated in any excipient the biological system or entity can tolerateto produce compositions or formulations for the administration of theMicronized Wharton's Jelly to a subject. Examples of aqueous excipientsinclude, but are not limited to, water, aqueous hyaluronic acid, saline,Ringer's solution, dextrose solution, Hank's solution, and other aqueousphysiologically balanced salt solutions. Nonaqueous vehicles, such asfixed oils, vegetable oils such as olive oil and sesame oil,triglycerides, propylene glycol, polyethylene glycol, and injectableorganic esters such as ethyl oleate can also be used. Other usefulformulations include suspensions containing viscosity enhancing agents,such as carboxymethylcellulose or salts thereof, sorbitol, or dextran.Excipients can also contain minor amounts of additives, such assubstances that enhance isotonicity and chemical stability. Examples ofbuffers include phosphate buffer, bicarbonate buffer and Tris buffer,while examples of preservatives include thimerosol, cresols, formalinand benzyl alcohol. In certain aspects, the pH can be modified dependingupon the mode of administration. Additionally, the compositions orformulations for the administration of the Micronized Wharton's Jelly toa subject can include carriers, thickeners, diluents, preservatives,surface active agents and the like in addition to the MicronizedWharton's Jelly described herein.

In some embodiments, the composition further comprises micronizedplacenta tissue or a component thereof, such as micronized placentalamnion, as described in International Patent Application WO 2012/112410,as well as in U.S. provisional application Ser. Nos. 61/442,346,61/543,995, and 61/683,700. The contents of these applications arespecifically incorporated herein by reference in their entireties. Insuch embodiments, the micronized placenta tissue or component thereofcan be added prior to and/or following micronization, and/or prior toand/or following dehydrating the Native Wharton's Jelly or UmbilicalCord Tissue as described in detail above.

In another aspect, placental tissue, or a component thereof, such asamnion, the intermediate tissue layer, chorion, and additionalcomponents, can be added prior to and/or following micronization, and/orprior to and/or following dehydrating the Native Wharton's Jelly orUmbilical Cord Tissue as described in detail above.

In one aspect, a filler can be added prior to and/or followingmicronization, and/or prior to and/or following dehydrating the NativeWharton's Jelly or Umbilical Cord Tissue as described in detail above.Examples of fillers include, but are not limited to, allograftpericardium, allograft acellular dermis, purified xenograft Type-1collagen, biocellulose polymers or copolymers, biocompatible syntheticpolymer or copolymer films, purified small intestinal submucosa, bladderacellular matrix, cadaveric fascia, or any combination thereof.

In another aspect, a bioactive agent can be added prior to and/orfollowing micronization, and/or prior to and/or following dehydratingthe Native Wharton's Jelly or Umbilical Cord Tissue as described indetail above. Examples of bioactive agents include, but are not limitedto, naturally occurring growth factors sourced from plateletconcentrates, either using autologous blood collection and separationproducts, or platelet concentrates sourced from expired banked blood;bone marrow aspirate; stem cells derived from concentrated humanplacental cord blood stem cells, concentrated amniotic fluid stem cellsor stem cells grown in a bioreactor; or antibiotics. Upon administrationof the Micronized Wharton's Jelly with bioactive agent to the region ofinterest on a subject, the bioactive agent is delivered to the regionover a period of time. Thus, the Micronized Wharton's Jelly or acomposition thereof as described herein is a useful delivery vehicle forbioactive agents and other pharmaceutical agents when administered to asubject. As would be understood by one skilled in the art, releaseprofiles of the bioactive agents from the Micronized Wharton's Jellycomposition as described herein can be modified based on, among otherthings, the selection of the components comprising the MicronizedWharton's Jelly composition as well as the size of the particles.

The compositions or formulations for the administration of theMicronized Wharton's Jelly to a subject can be prepared using techniquesknown in the art. In one aspect, compositions or formulations areprepared by admixing Micronized Wharton's Jelly described herein with apharmaceutically-acceptable compound and/or carrier.

It will be appreciated that the amount of Micronized Wharton's Jelly ina specified composition will vary according to the size of the particlesin the Micronized Wharton's Jelly being utilized, the particularcompositions formulated, the mode of application or delivery, and theparticular situs or region and subject being treated. Dosages for agiven subject can be determined using conventional considerations. Forexample, physicians and formulators, skilled in the art of determiningdoses and/or dosing regimens of the compositions or formulations for theadministration of the Micronized Wharton's Jelly to a subject, can todetermine the appropriate dose or dosing regimen according to standardrecommendations (Physician's Desk Reference, Barnhart Publishing(1999)).

In some embodiments, the Micronized Wharton's Jelly can be suspended ina pharmaceutically acceptable aqueous carrier, such as saline, sterilewater, or any suitable buffer known in the art to form a suspension or agelatinous gel composition. The composition can thus be in the form of aliquid, gel, or paste.

In some embodiments, sterile water is used to create a flowable gelcomposition comprising Micronized Wharton's Jelly that is suitable forinjection with a syringe and needle while maintaining a controlledviscosity of such flowable gel composition such that when delivered tothe injured region of a subject, it remains substantially localized withlittle or no migration out of the injured region for the repair and/orregeneration thereof. For example, about 0.1 to about 1 g (such as about0.5 g) of Micronized Wharton's Jelly can be mixed with about 1 mL toabout 2 mL (such as about 1.3-1.4 mL) of water to provide a flowable gelmaterial. In some embodiments, the concentration of the MicronizedWharton's Jelly in the composition is about 0.05 g/mL to about 1 g/mL,such as about 0.05 g/mL, about 0.1 g/mL, about 0.2 g/mL, about 0.3 g/mL,about 0.4 g/mL, about 0.5 g/mL, about 0.6 g/mL, about 0.7 g/mL, about0.8 g/mL, about 0.9 g/mL, about 1 g/mL, or any ranges between any twovalues, including the end points. The material is in a smoothconsistency that is able to be loaded into a syringe and pass through aneedle, such as a 25-27 gauge needle, wherein the viscosity of theflowable gel remains substantially unchanged.

In some embodiments, droplets of the flowable gel as described above isapplied onto a surface, such as a smooth and non-embossed surface of aboard, and allowed to dry substantially or completely. In someembodiments, the diameter of droplets are about 5 to about 1 mm, such asabout 2.5 mm. After drying, solid pellets form with minimum reduction inoverall diameter. In some embodiments, the solid pellets are in acircular shape/configuration. As used herein, substantially means thatthe dried pellets comprises no more than about 10%, about 5%, about 2%,about 1%, about 0.5% or about 0.1% residue water.

The pellets can be placed in sterile water to re-hydrate. In someembodiments the re-hydration time is about or more than about 1 hour. Insome embodiments, the diameter of the pellets increases afterrehydration. In some embodiments, the diameter increases by about 1.1 toabout 3 fold, such as about 1.5 to about 2.5 fold or about 2 fold. Insome embodiments, there is no indication of loss of integrity in size orshape in aqueous condition for an extended period, such as more thanabout 24 hours.

In some embodiments, the Micronized Wharton's Jelly is compressed into amold having a desired shape or size to form a molded MicronizedWharton's Jelly that takes the shape and size of the mold and exhibits adesired cohesiveness and density. It is within the purview of one ofordinary skill in the art to select suitable molding material, such assilicone, resin, Teflon®, or stainless steel, to form a mold of desiredshape and size.

The compositions or formulations for the administration of theMicronized Wharton's Jelly to a subject described herein can beadministered in a number of ways depending on whether local or systemictreatment is desired, and on the area to be treated. In one aspect,administration can be by injection, where the composition is formulatedinto a liquid or gel. In other aspects, the composition can beformulated to be applied internally to a subject. In other aspects, thecomposition can be applied topically (including ophthalmically,vaginally, rectally, intranasally, orally, or directly to the skin).

In one aspect, the compositions of Micronized Wharton's Jelly can beformulated as a topical composition applied directly to the skin.Formulations for topical administration can include, emulsions, creams,aqueous solutions, oils, ointments, pastes, gels, lotions, milks, foams,suspensions and powders. In one aspect, the topical composition caninclude one or more surfactants and/or emulsifiers. Topical applicationof Micronized Wharton's Jelly is particularly well suited for thetreatment of burns, psoriatic sores, dermatitis, wrinkles, and the like.

Micronized Wharton's Jelly compositions described herein can furthercomprise a surfactant (or surface-active substances) or emulsifier.

The surfactants may be anionic, non-ionic, cationic and/or amphotericsurfactants. Typical examples of anionic surfactants include, but arenot limited to, soaps, alkylbenzenesulfonates, alkanesulfonates, olefinsulfonates, alkyl ether sulfonates, glycerol ether sulfonates,alpha-methyl ester sulfonates, sulfo fatty acids, alkyl sulphates, fattyalcohol ether sulphates, glycerol ether sulphates, fatty acid ethersulphates, hydroxy mixed ether sulphates, monoglyceride (ether)sulphates, fatty acid amide (ether) sulphates, mono- and dialkylsulfosuccinates, mono- and dialkyl sulfosuccinamates,sulfotriglycerides, amide soaps, ether carboxylic acids and saltsthereof, fatty acid isethionates, fatty acid sarcosinates, fatty acidtaurides, N-acylamino acids, e.g. acyl lactylates, acyl tartrates, acylglutamates and acyl aspartates, alkyl oligoglucoside sulphates, proteinfatty acid condensates (in particular wheat-based vegetable products)and alkyl (ether) phosphates. Examples of non-ionic surfactants include,but are not limited to, fatty alcohol polyglycol ethers, alkylphenolpolyglycol ethers, fatty acid polyglycol esters, fatty acid amidepolyglycol ethers, fatty amine polyglycol ethers, alkoxylatedtriglycerides, mixed ethers or mixed formals, optionally partiallyoxidized alk(en)yl oligoglycosides or glucoronic acid derivatives, fattyacid N-alkylglucamides, protein hydrolysates (in particular wheat-basedvegetable products), polyol fatty acid esters, sugar esters, sorbitanesters, polysorbates and amine oxides. Examples of amphoteric orzwitterionic surfactants include, but are not limited to, alkylbetaines,alkylamidobetaines, aminopropionates, aminoglycinates,imidazolinium-betaines and sulfobetaines.

In one aspect, the surfactant can be fatty alcohol polyglycol ethersulphates, monoglyceride sulphates, mono- and/or dialkylsulfosuccinates, fatty acid isethionates, fatty acid sarcosinates, fattyacid taurides, fatty acid glutamates, alpha-olefinsulfonates, ethercarboxylic acids, alkyl oligoglucosides, fatty acid glucamides,alkylamidobetaines, amphoacetals and/or protein fatty acid condensates.

Examples of zwitterionic surfactants include betaines, such asN-alkyl-N,N-dimethylammonium glycinates, for examplecocoalkyldimethylammonium glycinate,N-acylaminopropyl-N,N-dimethylammonium glycinates, for examplecocoacylaminopropyldimethylammonium glycinate, and2-alkyl-3-carboxymethyl-3-hydroxyethylimidazolines having in each case 8to 18 carbon atoms in the alkyl or acyl group, andcocoacylaminoethylhydroxyethyl-carboxymethyl glycinate.

In one aspect, the emulsifier can be a nonionogenic surfactant selectedfrom the following: addition products of from 2 to 30 mol of ethyleneoxide and/or 0 to 5 mol of propylene oxide onto linear fatty alcoholshaving 8 to 22 carbon atoms, onto fatty acids having 12 to 22 carbonatoms, onto alkylphenols having 8 to 15 carbon atoms in the alkyl group,and onto alkylamines having 8 to 22 carbon atoms in the alkyl radical;alkyl and/or alkenyl oligoglycosides having 8 to 22 carbon atoms in thealk(en)yl radical and the ethoxylated analogs thereof; addition productsof from 1 to 15 mol of ethylene oxide onto castor oil and/orhydrogenated castor oil; addition products of from 15 to 60 mol ofethylene oxide onto castor oil and/or hydrogenated castor oil; partialesters of glycerol and/or sorbitan with unsaturated, linear orsaturated, branched fatty acids having 12 to 22 carbon atoms and/orhydroxycarboxylic acids having 3 to 18 carbon atoms, and the adductsthereof with 1 to 30 mol of ethylene oxide; partial esters ofpolyglycerol (average degree of self-condensation 2 to 8),trimethylolpropane, pentaerythritol, sugar alcohols (e.g. sorbitol),alkyl glucosides (e.g. methyl glucoside, butyl glucoside, laurylglucoside), and polyglucosides (e.g. cellulose) with saturated and/orunsaturated, linear or branched fatty acids having 12 to 22 carbon atomsand/or hydroxycarboxylic acids having 3 to 18 carbon atoms, and theadducts thereof with 1 to 30 mol of ethylene oxide; mixed esters ofpentaerythritol, fatty acids, citric acid and fatty alcohols and/ormixed esters of fatty acids having 6 to 22 carbon atoms, methylglucoseand polyols, preferably glycerol or polyglycerol, mono-, di- andtrialkyl phosphates, and mono-, di- and/or tri-PEG alkyl phosphates andsalts thereof; wool wax alcohols; polysiloxane-polyalkyl-polyethercopolymers and corresponding derivatives; and block copolymers, e.g.polyethylene glycol-30 dipolyhydroxystearates. In one aspect, theemulsifier is a polyalkylene glycol such as, for example, polyethyleneglycol or polypropylene glycol. In another aspect, the emulsifier ispolyethylene glycol having a molecular weight 100 Da to 5,000 Da, 200 Dato 2,500 Da, 300 Da to 1,000 Da, 400 Da to 750 Da, 550 Da to 650 Da, orabout 600 Da.

In another aspect, the emulsifier is a poloxamer. In one aspect, thepoloxamer is a nonionic triblock copolymer composed of a centralhydrophobic chain of polyoxypropylene (e.g., (poly(propylene oxide))flanked by two hydrophilic chains of polyoxyethylene (e.g.,poly(ethylene oxide)). In one aspect, poloxamer has the formula

HO(C₂H₄O)_(b)(C₃H₆O)_(a)(C₂H₄O)_(b)OH

wherein a is from 10 to 100, 20 to 80, 25 to 70, or 25 to 70, or from 50to 70; b is from 5 to 250, 10 to 225, 20 to 200, 50 to 200, 100 to 200,or 150 to 200. In another aspect, the poloxamer has a molecular weightfrom 2,000 to 15,000, 3,000 to 14,000, or 4,000 to 12,000. Poloxamersuseful herein are sold under the tradename Pluronic® manufactured byBASF. Non-limiting examples of poloxamers useful herein include, but arenot limited to, Pluronic® F68, P103, P105, P123, F127, and L121.

In another aspect, the emulsifier is composed of one or more fattyalcohols. In one aspect, the fatty alcohol is a liner or branched C₆ toC₃₅ fatty alcohol. Examples of fatty alcohols include, but are notlimited to, capryl alcohol (1-octanol), 2-ethyl hexanol, pelargonicalcohol (1-nonanol), capric alcohol (1-decanol, decyl alcohol), undecylalcohol (1-undecanol, undecanol, hendecanol), lauryl alcohol (dodecanol,1-dodecanol), tridecyl alcohol (1-tridecanol, tridecanol,isotridecanol), myristyl alcohol (1-tetradecanol), pentadecyl alcohol(1-pentadecanol, pentadecanol), cetyl alcohol (1-hexadecanol),palmitoleyl alcohol (cis-9-hexadecen-1-ol), heptadecyl alcohol(1-n-heptadecanol, heptadecanol), stearyl alcohol (1-octadecanol),isostearyl alcohol (16-methylheptadecan-1-ol), elaidyl alcohol(9E-octadecen-1-ol), oleyl alcohol (cis-9-octadecen-1-ol), linoleylalcohol (9Z, 12Z-octadecadien-1-ol), elaidolinoleyl alcohol (9E,12E-octadecadien-1-ol), linolenyl alcohol (9Z, 12Z,15Z-octadecatrien-1-ol) elaidolinolenyl alcohol (9E, 12E,15-E-octadecatrien-1-ol), ricinoleyl alcohol(12-hydroxy-9-octadecen-1-ol), nonadecyl alcohol (1-nonadecanol),arachidyl alcohol (1-eicosanol), heneicosyl alcohol (1-heneicosanol),behenyl alcohol (1-docosanol), erucyl alcohol (cis-13-docosen-1-ol),lignoceryl alcohol (1-tetracosanol), ceryl alcohol (1-hexacosanol),montanyl alcohol, cluytyl alcohol (1-octacosanol), myricyl alcohol,melissyl alcohol (1-triacontanol), geddyl alcohol (1-tetratriacontanol),or cetearyl alcohol.

In one aspect, the carrier used to produce the composition is a mixturepolyethylene and one or more fatty alcohols. For example, the carrier iscomposed of 50% to 99% by weight, 75% to 99% by weight, 90% to 99% byweight, or about 95% by weight polyethylene glycol and 1% to 50% byweight, 1% to 25% by weight, 1% to 10% by weight, or about 5% by weightfatty alcohol. In a further aspect, the carrier is a mixture ofpolyethylene glycol and cetyl alcohol.

The Micronized Wharton's Jelly compositions can also include one or moreadditional components such as, fats, waxes, pearlescent waxes, bodyingagents, thickeners, superfatting agents, stabilizers, polymers, siliconecompounds, lecithins, phospholipids, biogenic active ingredients,deodorants, antimicrobial agents, antiperspirants, swelling agents,insect repellents, hydrotropes, solubilizers, preservatives, perfumeoils and dyes. Examples of each of these components are disclosed inU.S. Pat. No. 8,067,044, which is incorporated by reference with respectthese components.

The Micronized Wharton's Jelly compositions described herein can beprepared by mixing the Micronized Wharton's Jelly with a carrier for asufficient time such that the particles are substantially evenlydispersed throughout the carrier. In the case where the carrier iscomposed of two or more components, the components can be admixed withone another prior to the addition of the Micronized Wharton's Jelly. Theamount of Micronized Wharton's Jelly present in the composition can varydepending upon the application. In one aspect, the Micronized Wharton'sJelly is from about 0.1% to about 99%, about 0.5% to about 90%, about 1%to about 75%, about 1% to about 50%, about 1% to about 20%, about 1% toabout 10%, about 2% to about 5%, or about 3% by weight of thecomposition. Exemplary procedures for making Micronized Wharton's Jellycompositions described herein are provided in the Examples.

In addition to the advantages discussed above, the ability of the largerMicronized Wharton's Jelly particles to absorb fluids permits them to beadmixed with a variety of substances (e.g., any of the bioactive agentsdescribed herein) to produce compositions or formulations for theadministration of the Micronized Wharton's Jelly to a subject withenhanced activity. For example, the larger particles can be mixed withadditional hemostatic agents, such as antifibrinolytics, vitamin K,fibrinogen, and blood coagulation factors, to enhance blood clotting ata wound. In other aspects, the larger particles can be admixed withautogeneous materials such as bone derived from the patient. Here theMicronized Wharton's Jelly can be administered directly to theperiosteal interface. In other aspects, the larger micronized particlescan be admixed with fibrin glues to enhance wound healing. MicronizedWharton's Jelly can enhance the ability of the fibrin glue to formfibrin clots and enhance tissue repair. Thus, the larger particles incombination with the fibrin glue can further reduce the need of suturestypically used to close wounds.

In one embodiment, the Micronized Wharton's Jelly can be embedded intothe surface of the amnion or chorion which is to contact the tissuesurface of a subject. Conventional technology such as high velocitysprayer can result in surface loading of the Micronized Wharton's Jellyso as to result in enhanced release rates of growth factors and the likeinto the tissue.

Plasticizers

In yet another aspect, the Micronized Wharton's Jelly compositioncomponents are admixed with at least one plasticizer. The terms“plasticizer” and “plasticizing agent” can be used interchangeably inthe present invention. A plasticizing agent can include any agent orcombination of agents that can be added to modify the mechanicalproperties of the composition or a product formed from the composition.One skilled in the art would select a suitable plasticizer based on thebiocompatibility of the plasticizer, effect of plasticizer on thedegradation or erosion rate of the Micronized Wharton's Jellycomposition in vivo, effect of the plasticizer on the properties of themixture to facilitate the molding/compression process, and/or effect ofthe plasticizer on the strength, flexibility, consistency,hydrophobicity and/or hydrophilicity of the composition. In someaspects, the plasticizer is dehydrated and/or micronized prior to beingmixed with the Micronized Wharton's Jelly such that the mixture ofplasticizer and Micronized Wharton's Jelly has a sufficiently low watercontent to permit compression in a non-porous mold.

Without intending to be bound by any theory or mechanism of action,plasticizers can be added, for example, to reduce crystallinity, lowerthe glass-transition temperature (Tg), or reduce the intermolecularforces between components within the composition, with a design goalthat may include creating or enhancing a flow between components in thecomposition. The mechanical properties that are modified include, butare not limited to, Young's modulus, tensile strength, impact strength,tear strength, and strain-to-failure. A plasticizer can be monomeric,polymeric, co-polymeric, or a combination thereof, and can be added to acomposition with or without covalent bonding. Plasticization andsolubility are analogous to the extent that selecting a plasticizerinvolves considerations similar to the considerations in selecting asolvent such as, for example, polarity. Furthermore, plasticizers canalso be added to a composition through covalent bonding that changes themolecular structure of the composition through copolymerization.

Examples of plasticizing agents include, but are not limited to, lowmolecular weight polymers such as, for example, single-block polymers,multi-block polymers, and copolymers; oligomers such as, for example,lactic acid oligomers including, but not limited to, ethyl-terminatedoligomers of lactic acid; dimers of cyclic lactic acid and glycolicacid; small organic molecules; hydrogen bond forming organic compoundswith and without hydroxyl groups; polyols such as low molecular weightpolyols having aliphatic hydroxyls; alkanols such as butanols, pentanolsand hexanols; sugar alcohols and anhydrides of sugar alcohols;polyethers such as poly(alkylene glycols); esters such as citrates,phthalates, sebacates and adipates; polyesters; aliphatic acids;saturated and unsaturated fatty acids; fatty alcohols; cholesterol;steroids; phospholipids such as, for example, lecithin; proteins such asanimal proteins and vegetable proteins; oils such as, for example, thevegetable oils and animal oils; silicones; acetylated monoglycerides;diglycerides; triglycerides; amides; acetamides; sulfoxides; sulfones;pyrrolidones; oxa acids; diglycolic acids; and any analogs, derivatives,copolymers and combinations thereof.

In some embodiments, the plasticizers include, but are not limited toother polyols such as, for example, caprolactone diol, caprolactonetriol, sorbitol, erythritol, glucidol, mannitol, sorbitol, sucrose, andtrimethylol propane. In other embodiments, the plasticizers include, butare not limited to, glycols such as, for example, ethylene glycol,diethylene glycol, Methylene glycol, tetraethylene glycol, propyleneglycol, butylene glycol, 1,2-butylene glycol, 2,3-butylene glycol,styrene glycol, pentamethylene glycol, hexamethylene glycol;glycol-ethers such as, for example, monopropylene glycol monoisopropylether, propylene glycol monoethyl ether, ethylene glycol monoethylether, and diethylene glycol monoethyl ether; and any analogs,derivatives, copolymers and combinations thereof.

In other embodiments, the plasticizers include, but are not limited toesters such as glycol esters such as, for example, diethylene glycoldibenzoate, dipropylene glycol dibenzoate, methylene glycolcaprate-caprylate; monostearates such as, for example, glycerolmonostearate; citrate esters; organic acid esters; aromatic carboxylicesters; aliphatic dicarboxylic esters; fatty acid esters such as, forexample, stearic, oleic, myristic, palmitic, and sebacic acid esters;triacetin; poly(esters) such as, for example, phthalate polyesters,adipate polyesters, glutate polyesters, phthalates such as, for example,dialkyl phthalates, dimethyl phthalate, diethyl phthalate, isopropylphthalate, dibutyl phthalate, dihexyl phthalate, dioctyl phthalate,diisononyl phthalate, and diisodecyl phthalate; sebacates such as, forexample, alkyl sebacates, dimethyl sebacate, dibutyl sebacate;hydroxyl-esters such as, for example, lactate, alkyl lactates, ethyllactate, butyl lactate, allyl glycolate, ethyl glycolate, and glycerolmonostearate; citrates such as, for example, alkyl acetyl citrates,triethyl acetyl citrate, tributyl acetyl citrate, trihexyl acetylcitrate, alkyl citrates, triethyl citrate, and tributyl citrate; estersof castor oil such as, for example, methyl ricinolate; aromaticcarboxylic esters such as, for example, trimellitic esters, benzoicesters, and terephthalic esters; aliphatic dicarboxylic esters such as,for example, dialkyl adipates, alkyl allylether diester adipates,dibutoxyethoxyethyl adipate, diisobutyl adipate, sebacic esters, azelaicesters, citric esters, and tartaric esters; and fatty acid esters suchas, for example, glycerol, mono- di- or triacetate, and sodium diethylsulfosuccinate; and any analogs, derivatives, copolymers andcombinations thereof.

In other embodiments, the plasticizers include, but are not limited toethers and polyethers such as, for example, poly(alkylene glycols) suchas poly(ethylene glycols) (PEG), poly(propylene glycols), andpoly(ethylene/propylene glycols); PEG derivatives such as, for example,methoxy poly(ethylene glycol) (mPEG); and ester-ethers such as, forexample, diethylene glycol dibenzoate, dipropylene glycol dibenzoate,and triethylene glycol caprate-caprylate; and any analogs, derivatives,copolymers and combinations thereof.

In other embodiments, the plasticizers include, but are not limited to,amides such as, for example, oleic amide, erucic amide, and palmiticamide; alkyl acetamides such as, for example, dimethyl acetamide;sulfoxides such as for example, dimethyl sulfoxide (DMSO); pyrrolidonessuch as, for example, n-methyl pyrrolidone; sulfones such as, forexample, tetramethylene sulfone; acids such as, for example, oxamonoacids, oxa diacids such as 3,6,9-trioxaundecanedioic acid, polyoxadiacids, ethyl ester of acetylated citric acid, butyl ester ofacetylated citric acid, capryl ester of acetylated citric acid, anddiglycolic acids such as dimethylol propionic acid; and any analogs,derivatives, copolymers and combinations thereof.

In other embodiments, the plasticizers include, but are not limited tovegetable oils including, but not limited to, epoxidized soybean oil;linseed oil; castor oil; coconut oil; fractionated coconut oil;epoxidized tallates; and esters of fatty acids such as stearic, oleic,myristic, palmitic, and sebacic acid; essential oils including, but notlimited to, angelica oil, anise oil, arnica oil, aurantii aetheroleum,valerian oil, basilici aetheroleum, bergamot oil, savory oil, buccoaetheroleum, camphor, cardamomi aetheroleum, cassia oil, chenopodiumoil, chrysanthemum oil, cinae aetheroleum, citronella oil, lemon oil,citrus oil, costus oil, curcuma oil, carlina oil, elemi oil, tarragonoil, eucalyptus oil, fennel oil, pine needle oil, pine oil, filicis,aetheroleum, galbanum oil, gaultheriae aetheroleum, geranium oil, guaiacwood oil, hazelwort oil, iris oil, hypericum oil, calamus oil, chamomileoil, fir needle oil, garlic oil, coriander oil, carraway oil, lauriaetheroleum, lavender oil, lemon grass oil, lovage oil, bay oil, lupulistrobuli aetheroleum, mace oil, marjoram oil, mandarine oil, melissaoil, menthol, millefolii aetheroleum, mint oil, clary oil, nutmeg oil,spikenard oil, clove oil, neroli oil, niaouli, olibanum oil, ononidisaetheroleum, opopranax oil, orange oil, oregano oil, orthosiphon oil,patchouli oil, parsley oil, petit-grain oil, peppermint oil, tansy oil,rosewood oil, rose oil, rosemary oil, rue oil, sabinae aetheroleum,saffron oil, sage oil, sandalwood oil, sassafras oil, celery oil,mustard oil, serphylli aetheroleum, immortelle oil, fir oil, teatreeoil, terpentine oil, thyme oil, juniper oil, frankincense oil, hyssopoil, cedar wood oil, cinnamon oil, and cypress oil; and other oils suchas, for example, fish oil; and any analogs, derivatives, copolymers andcombinations thereof.

It should be appreciated that, in some embodiments, one of skill in theart may select one or more particular plasticizing agents in order toexclude any one or any combination of the above-described plasticizingagents.

In some embodiments, the plasticizing agent can include a component thatis water-soluble. In other embodiments, the plasticizing agent can bemodified to be water-soluble. In some embodiments, the plasticizingagent can include a component that is lipid-soluble. In otherembodiments, the plasticizing agent can be modified to be lipid-soluble.Any functional group can be added to modify the plasticizer's behaviorin a solvent such as, for example, body fluids that are present in vivo.

Cross-Linking

In a further aspect, the potential in vivo degradation or erosion rateof Micronized Wharton's Jelly compositions formulations according to thepresent invention, as well as the density and cohesiveness of theMicronized Wharton's Jelly and other components, can be modified, forexample, by cross-linking. The Micronized Wharton's Jelly can becross-linked with other components, such as the amnion tissue,intermediate tissue layer, chorion, or a second amnion tissue. Forexample, a cross-linking agent can be added prior to and/or aftermicronization as described herein. In general, the cross-linking agentis nontoxic and non-immunogenic. When the components are treated withthe cross-linking agent, the cross-linking agent can be the same ordifferent. In one aspect, the Native Wharton's Jelly, Umbilical CordTissue (with or without Native Wharton's Jelly, and/or other componentscan be treated separately with a cross-linking agent or, in thealternative, Native Wharton's Jelly, Umbilical Cord Tissue (with orwithout Native Wharton's Jelly, and/or other components can be treatedtogether with the same cross-linking agent. In certain aspects, NativeWharton's Jelly, Umbilical Cord Tissue (with or without Native Wharton'sJelly, and/or other components can be treated with two or more differentcross-linking agents. The conditions for treating the Native Wharton'sJelly, Umbilical Cord Tissue (with or without Native Wharton's Jelly,and/or other components can vary. In other aspects, Micronized Wharton'sJelly can subsequently be treated with a cross-linking agent. In oneaspect, the concentration of the cross-linking agent is from about 0.1 Mto about 5 M, about 0.1 M to about 4 M, about 0.1 M to about 3 M, about0.1 M to about 2 M, or about 0.1 M to about 1 M. Preferably, NativeWharton's Jelly, Umbilical Cord Tissue (with or without Native Wharton'sJelly, and/or other components are cross-linked prior to dehydrationsuch that the cross-linked components have a sufficiently low watercontent to permit compression or molding in a non-porous mold.

In certain aspects, a molded Micronized Wharton's Jelly as describedbelow can be treated with the cross-linking agent. Preferably, thecomposition is subjected to gas/fume cross-linking prior to compressionand before or after micronization such that the water content of thecomposition is maintained at a low level, e.g., less than about 20%,less than about 15%, less than about 10%, or less than about 5%. Thecross-linking agent generally possesses two or more functional groupscapable of reacting with proteins to produce covalent bonds. In oneaspect, the cross-linking agent possesses groups that can react withamino groups present on the protein. Examples of such functional groupsinclude, but are not limited to, hydroxyl groups, substituted orunsubstituted amino groups, carboxyl groups, and aldehyde groups. In oneaspect, the cross-linker can be a dialdehyde such as, for example,glutaraldehyde. In another aspect, the cross-linker can be acarbodiimide such as, for example,(N-(3-dimethylaminopropyl)-N′-ethyl-carbodiimide (EDC). In otheraspects, the cross-linker can be an oxidized dextran, p-azidobenzoylhydrazide, N-[alpha-maleimidoacetoxy]succinimide ester, p-azidophenylglyoxal monohydrate, bis-[beta-(4-azidosalicylamido)ethyl]disulfide,bis-[sulfosuccinimidyl]suberate, dithiobis[succinimidyl]propionate,disuccinimidyl suberate, and1-ethyl-3-[3-dimethylaminopropyl]carbodiimide hydrochloride, abifunctional oxirane (OXR), ethylene glycol diglycidyl ether (EGDE),nordihydroguaiaretic acid (NDGA).

In one aspect, sugar is the cross-linking agent, where the sugar canreact with proteins present in the Native Wharton's Jelly, UmbilicalCord Tissue (with or without Native Wharton's Jelly, and/or othercomponents to form a covalent bond. For example, the sugar can reactwith proteins by the Maillard reaction, which is initiated by thenonenzymatic glycosylation of amino groups on proteins by reducingsugars and leads to the subsequent formation of covalent bonds. Examplesof sugars useful as cross-linking agents include, but are not limitedto, D-ribose, glycerose, altrose, talose, ertheose, glucose, lyxose,mannose, xylose, gulose, arabinose, idose, allose, galactose, maltose,lactose, sucrose, cellibiose, gentibiose, melibiose, turanose,trehalose, isomaltose, or any combination thereof.

Molded Compositions

In some embodiments, the Micronized Wharton's Jelly in the form offlowable gel material can be placed in a mold with an appropriate sizeand shape and allowed to dry in the mold to form a solid moldedcomposition suitable for placing into, for example, a drill fracture ofthe articular cartilage. Accordingly, in one embodiment, a method isprovided for producing a molded composition comprising MicronizedWharton's Jelly having a preselected disintegration rate in vivo. It isto be understood that altering particle size allows for predictablechanges in the disintegration rate of the molded composition. Accordingto one embodiment, the Micronized Wharton's Jelly is molded underpressure wherein the particle size is adjusted as described above priorto said molding so as to provide a molded composition having apreselected disintegration rate. In one embodiment, the disintegrationrate in vivo can be reduced (slowed) by decreasing the particle size ofthe Micronized Wharton's Jelly.

In another aspect, altering one or more of for the particle size ofMicronized Wharton's Jelly, the compression force used, and the rate atwhich the compression force is applied allows for predictable changes inthe stiffness and/or strength of the molded composition. Accordingly,further provided is a method for producing a molded Micronized Wharton'sJelly composition having a preselected strength and/or stiffness, saidmethod comprising molding Micronized Wharton's Jelly under pressurewherein one or more of the above parameters is adjusted prior to saidmolding so as to provide a molded a composition having a preselectedstrength and/or stiffness. In one embodiment, the strength of the moldedcomposition can be increased by decreasing the particle size of theMicronized Wharton's Jelly, while maintaining each of the other factorslisted above. In one embodiment, the strength of the molded compositioncan be increased by increasing the compression force used. In oneembodiment, the strength of the molded composition can be increased bydecreasing the compression rate used.

The Micronized Wharton's Jelly, when subjected to pressure preferably ina non-porous mold, forms a desired shape and size defined by the mold.While a porous mold is less preferred, it is contemplated that such canbe used in the methods of the present invention if water or othersolvents are allowed to escape during molding.

The compression force, compression rate, and number of compressioncycles can vary during the formation of the molded, Micronized Wharton'sJelly composition. In one aspect, the compression force used to mold theMicronized Wharton's Jelly is between about 10 Newtons and about 1000Newtons. In another embodiment, the compression force used is betweenabout 100 Newtons and about 400 Newtons. The compression force can varybased on the intended use. For example, a use requiring greater strengthand/or stiffness of the molded composition will require a greater force.

In one aspect, the compression rate used to mold the MicronizedWharton's Jelly is between about 0.001 mm/sec and about 5 mm/sec. Inanother embodiment, the compression rate is between about 0.008 mm/secand about 1.5 mm/sec. The compression rate can vary based on theintended use. For example, a use requiring greater strength and/orstiffness of the molded composition will require a slower rate.

The molded Micronized Wharton's Jelly composition has a sufficientdensity and cohesive mass to maintain its size and shape at least untilthe molded composition is introduced to a subject. The cohesion of themolded composition is determined, in part, by the particle size of theMicronized Wharton's Jelly. For example, Micronized Wharton's Jellyhaving larger particle size require higher compressive pressure and/orlonger compression time to obtain a molded Micronized Wharton's Jellycomposition having the same density as that of a molded MicronizedWharton's Jelly composition composed of dehydrated Micronized Wharton'sJelly having smaller particle size. In other words, for moldedMicronized Wharton's Jelly compositions obtained under the samecompression condition, the compositions having larger particle size haveless density and dissociate at a higher rate in comparison to thecompositions having smaller particle size.

The particle size of the Micronized Wharton's Jelly compositions alsoaffects the release rate of the growth factors and other activemolecules present in the composition. Without being bound by theory andwith all other factors being equal, it is contemplated that smallerparticle size creates a larger overall surface area of components withinthe composition. A larger surface area may result in an increasedrelease of factors from the Micronized Wharton's Jelly, and/or a fasterrate of release. Smaller particles are contemplated to allow forimproved compressibility and increased strength. Molded, MicronizedWharton's Jelly compositions made with larger particles may disintegratefaster than those made with smaller particles. Therefore, the particlesize of the Micronized Wharton's Jelly can be optimized, therebyobtaining the molded Micronized Wharton's Jelly composition having adesired cohesiveness, surface area, and desired end results whenadministered to a subject.

Optionally, one or more adhesives can be admixed with the MicronizedWharton's Jelly prior to being introduced into the mold. Examples ofsuch adhesives include, but are not limited to, fibrin sealants,cyanoacrylates, gelatin and thrombin products, polyethylene glycolpolymer, albumin, and glutaraldehyde products. The adhesives used in theprocess should be dehydrated prior to being mixed with the micronizedamnion composition such that the mixture of adhesives and micronizedamnion composition has a sufficiently low water content to permitcompression in a non-porous mold.

In addition to Dehydrated Tissue as described above, additionaldehydrated components such as amnion, the intermediate tissue layer,and/or chorion, can be added to the composition prior to and/or aftermicronization. In one aspect, dehydrated filler can be added. Examplesof fillers include, but are not limited to, allograft pericardium,allograft acellular dermis, purified Type-1 collagen, biocellulosepolymers or copolymers, biocompatible synthetic polymer or copolymerfilms, purified small intestinal submucosa, bladder acellular matrix,cadaveric fascia, bone particles (including cancellous and cortical boneparticles), or any combination thereof.

In another aspect, a dehydrated bioactive agent can be added to thecomposition prior to and/or after micronization. Examples of bioactiveagents include, but are not limited to, naturally occurring growthfactors sourced from platelet concentrates, either using autologousblood collection and separation products, or platelet concentratessourced from expired banked blood; bone marrow aspirate; stem cellsderived from concentrated human placental cord blood stem cells,concentrated amniotic fluid stem cells or stem cells grown in abioreactor; or antibiotics. Upon application of the molded, dehydratedMicronized Wharton's Jelly composition with bioactive agent to theregion of interest, the bioactive agent is delivered to the region overtime. Thus, the molded, dehydrated Micronized Wharton's Jellycompositions described herein are useful as delivery vehicles ofbioactive agents and other cosmetic agents when administered to asubject. Release profiles can be modified based on, among other things,the selection of the components used to make the molded composition aswell as the size of the particles contained in the composition.

Injectable Compositions

In one aspect, provided Micronized Wharton's Jelly that is suitable forinjection with a syringe and needle while maintaining a controlledviscosity of such flowable gel composition such that when delivered tothe injured region of a subject, it remains substantially localized withlittle or no migration out of the injured region for the repair and/orregeneration thereof. In preferred embodiments, the injectablecomposition is a gel. Aqueous forms of the Micronized Wharton's Jellycompositions generally form a gel, but these gels may further includegel-forming pharmaceutically acceptable polymers such as gelatin,methylcellulose and polyethylene glycol.

It is contemplated that the injectable gels of Micronized Wharton'sJelly disclosed herein can been used as vehicles for the treatment ofpatients to sustain the in vivo release of biologically active compoundsfound in Native Wharton's Jelly. While the diffusion of biologicallyactive compounds through Native Wharton's Jelly is hindered by theviscosity of these systems as well as the tortuous diffusion path thatresults from the three dimensional polymeric network that is present,such hindrances are overcome by the Micronized Wharton's Jellyformulations and compositions of the present invention.

The injectable gels of Micronized Wharton's Jelly may include one ormore of an osmotic agent, hydrophobic agent, and surface active agent.Osmotic agents increase the rate of water sorption into the gel andprovide an increase in the rate of release of the biologically activecompounds found in Native Wharton's Jelly. Any conventional osmoticagents may be used in accordance with the invention. Preferred osmoticagents include mannitol, dextrose, and sodium chloride. Hydrophobicagents reduce the rate of elimination of the gel from the injection siteand decrease the rate of release of the biologically active compoundsfound in Native Wharton's Jelly. Any conventional hydrophobic agents maybe used in accordance with the invention. Preferred hydrophobic agentsinclude cholesterol and cholesterol derivatives such as cholesterolsulfate, cholesterol acetate and cholesterol hemisuccinate. Surfaceactive agents increase the rate of elimination of the gel from theinjection site and provide an initially high rate of release of thebiologically active compounds found in Wharton's jelly. Any conventionalsurface active agents may be used in accordance with the invention.Preferred surface active agents are stearic acid, palmitic acid, C₆-C₂₆carboxylic acids, and the salts of these acids. Other surface activeagents include polyoxyethylene glycols (e.g., PLURONIC's) andpolyoxyethylene sorbitan mono-oleates (e.g., POLYSORBATE's).

In some embodiments, the injectable gel comprising Micronized Wharton'sJelly can be used to treat a patient by injecting the gel into thepatient to both repair and regenerate the patient's articular surfacecartilage.

In further embodiments, the injectable comprising Micronized Wharton'sJelly can be used to treat a patient by injecting the gel into thesynovial joints of a patient. Synovial fluid is responsible for theoperation and protection of the joints. Synovial fluid has visoelasticproperties that lubricate the joint and absorb shock. However, indegenerative knee osteoarthritis for example, the synovial fluiddegrades and ceases to protect the joint.

Viscosupplementation therapy involves injecting a gel into the joint toreplace faulty synovial fluid. Viscosupplementation can reduce oreliminate pain and help restore joint mobility. Viscosupplementationproducts currently on the market are gels that contain hyaluronic acid.However, the persistence of gels based on hyaluronic acid is low in ajoint (hours to days) because the hyaluronic acid readily degrades invivo.

In contrast, it is contemplated that the injectable gels comprisingMicronized Wharton's Jelly can persist at the site of injection, such ason an articular surface cartilage or at a synovial joint, from about 6to about 12 hours, about 12 to about 14 hours, about 24 hours to about36 hours, about 36 hours to about 48 hours, about 48 hours to about 60hours, about 60 hours to about 100 hours or more.

III. Treatment of Articular Surface Defects

In another aspect, a method of treating an articular surface defect isprovided.

Articular cartilage which serves as the lining of the joint has uniquebiochemical and physical qualities which confer nearly frictionlesscharacteristics. Articular surface defects can be caused by both acuteand repetitive trauma. A severe impact injury may cause injury to afocal area of an articular cartilage. Defects in the articular surfacemay lead to osteoarthrosis of the joint. Such defects can occur atjoints of such as, shoulders, elbows, knees, hips, feet, ankles, handand wrists, and the like. Three classes of chondral and osteochondralinjuries can be identified based on the type of tissue damage and therepair response: (1) damage to the joint surface that does not causevisible mechanical disruption of the articular surface, but does causechondral damage and may cause subchondral bone injury; (2) mechanicaldisruption of the articular surface limited to articular cartilage; and(3) mechanical disruption of articular cartilage and subchondral bone.

Articular surface defects can be graded based on the depth of the injuryof articular cartilage. Grade I is when the cartilage has a soft spot orblisters, Grade II refers to minor tears visible in the cartilage,including fissuring or crater depth less than half the full thickness,Grade III refers to lesions have deep crevices (more than 50% ofcartilage layer), including deep defects that are through most of thethickness of the cartilage, and the most severe, Grade IV refers to afull thickness defects with exposed bone.

Articular cartilage has poor healing qualities. An articular surfacedefect is difficult to heal or regenerate spontaneously. The approachesin addressing articular surface defects or articular cartilage defectstypically involve “repair” and/or “regeneration”. “Repair” refers tohealing of the injured tissue or replacement by cell proliferation andnew ECM. “Regeneration” refers to formation of entirely new articularsurface, preferably identical to the original tissue.

Native Wharton's Jelly is rich in ECM comprising a variety of fibrousproteins, interstitial proteins, and signaling molecules, includingglycosaminoglycans (GAGs), proteoglycans, and growth factors, includingtransforming growth factor beta 1 (TGF-β1), fibroblast growth factor(FGF), insulin-like growth factor I (IGF-I), platelet-derived growthfactor (PDGF) and epidermal growth factor (EGF). Native Wharton's Jellyis a unique ECM further due to in part by its collagen types, includingtypes I, II, III, IV, V, VI, and VII, and its ability to bind waterwithin specific various layers. Native Wharton's Jelly also has asignificant elasticity characteristic as well as binding of watermolecules. It is contemplated hat Native Wharton's Jelly will provideessential elements to both repair and regenerate articular surfacecartilage. In some embodiments, growth factors are introduced tofacilitate repair or regeneration. The growth factors canchemotactically cause cell proliferation, deliver ECM and directcellular differentiation to hyaline cartilage formation rather thanformation of the tough, dense, fibrous material fibrocartilage, which isnot smooth and glassy, and not ideal for joints.

One of the most widely used surgical techniques for cartilage repair isthe micro-fracture procedure. In this procedure, a disruption of thesubchondral bone and cartilage is done in an attempt to induce bleedingand stimulate bone marrow stem cells. In larger defects, small amountsof subchondral bone maybe removed and mixed with various other bonematerial in an effort to promote healing. In this application, theMicronized Wharton's Jelly or a composition or formulation thereof canbe added, such as to the autogenous bone tissue being removed, mixed andreplaced into the defect. In some embodiments, the Micronized Wharton'sJelly in the form of dried pellets, as described herein, is added. Insome embodiments, the dried pellets are press-fitted into a drill holesite. In some embodiments, the Micronized Wharton's Jelly in the form offlowable gel material as described herein is placed in a mold with anappropriate size and shape and allowed to dry in the mold to form asolid molded composition suitable for placing into the drill fracture ofthe articular cartilage. It is surprising that after drying, the solidmolded composition has minimum reduction in size. This allows reliabledesign of the shape and size of the mold according to the shape and sizeof the drill fracture in order to produce a solid molded compositionthat fits well in the fracture. Further, it is surprising that the solidcomposition, either in a pellet form or a molded form, does not readilyre-dissolve when placed in an aqueous environment. This allows theMicronized Wharton's Jelly composition to be maintained at the drillfracture site for an extended period of time (such as at least one day,one week, two week, one month, or until completion of repair orregeneration) to provide long term effect in assisting repair orregeneration of the articular surface cartilage.

In some embodiments, the Micronized Wharton's Jelly in the form of aflowable gel as described herein is injected directly into a drillfracture site.

In one aspect, the Micronized Wharton's Jelly compositions andformulations described herein are also useful in enhancing or improvingwound healing. The types of wounds that present themselves to physicianson a daily bases are diverse. Acute wounds are caused by surgicalintervention, trauma and burns. Chronic wounds are wounds that aredelayed in closing compared to healing in an otherwise healthyindividual. Examples of chronic wound types plaguing patients includediabetic foot ulcers, venous leg ulcers, pressure ulcers, arterialulcers, and surgical wounds that become infected.

IV. Use in Angioplasty

In still another aspect, provided is use of the gel compositioncomprising Micronized Wharton's Jelly in cardiovascular procedures, suchas angioplasty, a minimally invasive revascularization procedure. In anangioplasty procedure, an empty and collapsed balloon on a guide wire,known as a balloon catheter, is passed into a narrowed location of anobstructed artery in order to widen it. The narrowed location of anartery is often obstructed as a result of atherosclerosis. When reachingthe narrowed location, the balloon is inflated by, for example, applyingwater pressures. The balloon forces expansion of the inner white bloodcell/clot plaque deposits and the surrounding muscular wall, opening upthe blood vessel for improved flow. The balloon is then deflated andwithdrawn. A stent is optionally inserted at the time of ballooning toensure the vessel remains open.

However, recurrent stenosis (restenosis) can occur after suchendovascular treatment of atherosclerotic lesions in the peripheral,cerebrovascular, and coronary circulation. It has been reported that upto 60% of the patients receiving percutaneous angioplasty experiencerestenosis within the first 12 months post-procedure. Vascularinflammation after balloon angioplasty or stent implantation has beenidentified as a main cause of the restenotic process. Martin Schillingerand Erich Minar, Restenosis After Percutaneous Angioplasty: The Role ofVascular Inflammation, Vasc Health Risk Manag., Mar 2005; 1(1):73-78. Itis contemplated that Micronized Wharton's Jelly can be used in heartintervention procedures, such as angioplasty to reduce inflammation andformation of restenosis.

In some embodiments, the injectable gel composition described herein isinjected directly to the angioplasty or surgical site, or around theangioplasty site to reduce inflammation, prevent restenosis andfacilitate healing. In one embodiment, provided is a method ofpreventing or reducing restenosis in a patient having angioplasty and/orstent implantation, said method comprising administering an injectablecomposition comprising Micronized Wharton's Jelly approximate to thesite of the angioplasty and/or stent implantation. In some embodiments,the injectable gel composition is injected into the tissue proximate tothe vascular site to which the angioplasty is performed, at the time ofthe procedure, or before or after the procedure. For example, theinjectable gel composition is injected to the outside of the bloodvessel where angioplasty is performed and forms a coating of therelevant section of the blood vessel. The gel is contemplated to stay inplace for an extended period of time and provide a continuous supply ofanti-inflammatory molecules, such as growth factors, which can cross theblood vessel wall to the site of angioplasty to prevent and/or reduceinflammation and restenosis. In some embodiments, additional injectablegel composition is injected into the tissue proximate to the angioplastysite after the initial injection, such as one week, one month, twomonths, or six months, etc., after the initial injection. The injectionscan be made periodically, such as once a week, once a month, oncetwo-months, etc.

In some embodiments, the balloon used in the angioplasty procedure iscovered with the gel composition described herein and when the balloonis inflated, the gel composition is applied to the vessel wall, andremains on the vessel wall for a period of time to reduce inflammationand prevent restenosis. In some embodiments, the stent applied to theantioplasty site is covered with the gel composition described herein,which provides protection to the artery from inflammation and preventrestenosis when the stent is placed in the artery.

In some embodiments, the gel stays localized where it is placed for aperiod of time of from about 6 to about 12 hours, about 12 to about 14hours, about 24 hours to about 36 hours, about 36 hours to about 48hours, about 48 hours to about 60 hours, about 60 hours to about 100hours or more.

The following Examples are for illustrative purposes only and should notbe interpreted as limitations of the claimed invention.

EXAMPLES 1. Preparation of Umbilical Cord Tissue For Micronization

Umbilical Cord Tissue is obtained by dissecting the umbilical cord offthe placental disc during the standard process known in the art.Dissection continues by performing a vertical incision along the cordsegment which extends approximately 2-3 mm in depth. The umbilical cordarteries and veins are then removed via undermine dissection techniquewith care given to maintain as much Wharton's jelly tissue as possible.To maximize the dissection and recovery of Native Wharton's Jelly cordsections, the cord may be cut into smaller sections of 4-10 cm inlength. Upon completion of the dissection, section of the cord mayproceed with the standard Purion process wash and rinse step. Afterwashing and rinses are completed, cord segments are then placed onto adrying board with the Native Wharton's Jelly side facing upwards. Cordsections are dried to standard drying time specifications. Cord sectionsare then cut into 2×2 cm sections and prepared for micronization.

2. Micronization of Umbilical Cord Tissue

The dehydrated Umbilical Cord Tissue obtained according to the proceduredescribed in Example 1 is then micronized to provide MicronizedWharton's Jelly, with target particle sizes of 25 μm-75 μm.

3. Preparation of a Gel Composition of Micronized Wharton's Jelly

Sterile water was used to create a flowable gel configuration with theMicronized Wharton's jelly obtained in Example 2. To achieve a smoothconsistency capable of passing through a 25-27 gauge needle, 1358.08 μLof water was added to 0.504 g of Micronized Wharton's Jelly. Thisyielded 2.5 mL of flowable gel material comprising Micronized Wharton'sJelly which can be loaded onto a 1.0 cc syringe.

4. Preparation of a Pellet Composition of Micronized Wharton's Jelly

A 1.0 cc syringe was loaded with the Micronized Wharton's Jelly gelformulation prepared according to Example 3. Following loading and usingan open bore technique, droplets of Micronized Wharton's Jelly gel wasplaced onto a standard drying board (smooth side, non-embossed) suchthat the average droplet diameter was about 2.5 mm. Droplets wereallowed to dry completely for about 8 hours.

After drying, the droplets were observed to become solid pellets andmaintained a circular shape/configuration with minimum reduction inoverall diameter.

The pellets were then placed in sterile water to re-hydrate. The overalldiameter of the pellets was observed to increase by about 2-fold afterrehydration. No indication of loss of integrity in size or shape inaqueous condition for more than 24 hours.

5. Clinical Application of Micronized Wharton's Jelly

One of the most widely used surgical techniques for cartilage repair isthe “micro-fracture” procedure. In this procedure a disruption of thesubchondral bone and cartilage is done in an attempt to induce bleedingand stimulate bone marrow stem cells. In larger defects, small amountsof subchondral bone maybe removed and mixed with various bone othermaterial in an effort to promote healing. In this application,Micronized Wharton's Jelly pellets prepared according to Example 4 areadded to the autogenous bone tissue being removed, mixed and replacedinto the defect.

In the case of a micro-fracture, the Micronized Wharton's Jelly flowablegel material obtained according to Example 3 can be injected directlyinto the drill fracture sites or Micronized Wharton's Jelly pelletsobtained according to Example 4 can be press-fitted into each drill holesite.

1-35. (canceled)
 36. A method for inducing hyaline cartilage formationin a patient in need thereof, said method comprising introducing acomposition comprising Wharton's jelly into a joint of said patient,wherein hyaline cartilage formation is induced.
 37. The method of claim36, wherein the composition further comprises a pharmaceuticallyacceptable carrier.
 38. The method of claim 37, wherein thepharmaceutically acceptable carrier is selected from the groupconsisting of water, saline, and phosphate buffered saline.
 39. Themethod of claim 36, wherein the composition further comprises asurfactant or an emulsifier.
 40. The method of claim 36, wherein thecomposition further comprises a plasticizer.
 41. The method of claim 36,wherein the composition is injectable.
 42. The method of claim 36,wherein the composition is a liquid, a gel or a paste.
 43. The method ofclaim 36, wherein the composition further comprises a biocompatiblepolymer.
 44. The method of claim 43, wherein the biocompatible polymeris a plasticizer.
 45. The method of claim 44, wherein the plasticizer iscross-linked with a biocompatible cross-linking agent.
 46. The method ofclaim 36, wherein the composition further comprises amniotic membrane ofan umbilical cord.
 47. The method of claim 36, wherein the compositionis substantially free of amniotic membrane of an umbilical cord.
 48. Themethod of claim 36, wherein said patient suffers from an articularsurface defect.
 49. The method of claim 48, wherein the articularsurface defect is localized at a joint in a shoulder, elbows, knee, hip,feet, ankle, hand, and/or wrist of said patient.
 50. The method of claim49, wherein the composition is administered to the site of the articularsurface defect.
 51. The method of claim 36, wherein the composition isadministered to the patient during a micro-fracture procedure.
 52. Themethod of claim 36, wherein the composition is administered to a drillfracture site during a micro-fracture procedure.
 53. The method of claim36, wherein the composition is added to an autogenous bone tissue. 54.The method of claim 36, wherein the composition is administered to asynovial joint of said patient.
 55. The method of claim 36, wherein theWharton's jelly is micronized.